Aims: Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD extraction procedure and subsequent patient management. The aim of this analysis was to describe the procedure, management, and outcome of S-ICD extractions in clinical practice. Methods and results: We enrolled consecutive patients who required complete S-ICD extraction at 66 Italian centres. From 2013 to 2022, 2718 patients undergoing de novo implantation of an S-ICD were enrolled. Of these, 71 required complete S-ICD system extraction (17 owing to infection). The S-ICD system was successfully extracted in all patients, and no complications were reported; the median procedure duration was 40 (25th-75th percentile: 20-55) min. Simple manual traction was sufficient to remove the lead in 59 (84%) patients, in whom lead-dwelling time was shorter [20 (9-32) months vs. 30 (22-41) months; P = 0.032]. Hospitalization time was short in the case of both non-infectious [2 (1-2) days] and infectious indications [3 (1-6) days]. In the case of infection, no patients required post-extraction intravenous antibiotics, the median duration of any antibiotic therapy was 10 (10-14) days, and the re-implantation was performed during the same procedure in 29% of cases. No complications arose over a median of 21 months. Conclusion: The S-ICD extraction was safe and easy to perform, with no complications. Simple traction of the lead was successful in most patients, but specific tools could be needed for systems implanted for a longer time. The peri- and post-procedural management of S-ICD extraction was free from complications and not burdensome for patients and healthcare system. Clinical Trial Registration - URL: http://clinicaltrials.gov/Identifier: NCT02275637

Procedure, management and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice / De Filippo, Paolo; Migliore, Federico; Palmisano, Pietro; Nigro, Gerardo; Ziacchi, Matteo; Rordorf, Roberto; Pieragnoli, Paolo; Di Grazia, Angelo; Ottaviano, Luca; Francia, Pietro; Pisanò, Ennio; Tola, Gianfranco; Giammaria, Massimo; D'Onofrio, Antonio; Luca Botto, Giovanni; Zucchelli, Giulio; Ferrari, Paola; Lovecchio, Mariolina; Valsecchi, Sergio; Viani, Stefano. - In: EUROPACE. - ISSN 1532-2092. - 25:6(2023), pp. 1-8. [10.1093/europace/euad158]

Procedure, management and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice

Pietro Francia;
2023

Abstract

Aims: Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD extraction procedure and subsequent patient management. The aim of this analysis was to describe the procedure, management, and outcome of S-ICD extractions in clinical practice. Methods and results: We enrolled consecutive patients who required complete S-ICD extraction at 66 Italian centres. From 2013 to 2022, 2718 patients undergoing de novo implantation of an S-ICD were enrolled. Of these, 71 required complete S-ICD system extraction (17 owing to infection). The S-ICD system was successfully extracted in all patients, and no complications were reported; the median procedure duration was 40 (25th-75th percentile: 20-55) min. Simple manual traction was sufficient to remove the lead in 59 (84%) patients, in whom lead-dwelling time was shorter [20 (9-32) months vs. 30 (22-41) months; P = 0.032]. Hospitalization time was short in the case of both non-infectious [2 (1-2) days] and infectious indications [3 (1-6) days]. In the case of infection, no patients required post-extraction intravenous antibiotics, the median duration of any antibiotic therapy was 10 (10-14) days, and the re-implantation was performed during the same procedure in 29% of cases. No complications arose over a median of 21 months. Conclusion: The S-ICD extraction was safe and easy to perform, with no complications. Simple traction of the lead was successful in most patients, but specific tools could be needed for systems implanted for a longer time. The peri- and post-procedural management of S-ICD extraction was free from complications and not burdensome for patients and healthcare system. Clinical Trial Registration - URL: http://clinicaltrials.gov/Identifier: NCT02275637
2023
extraction; implantable defibrillator; infection; subcutaneous
01 Pubblicazione su rivista::01a Articolo in rivista
Procedure, management and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice / De Filippo, Paolo; Migliore, Federico; Palmisano, Pietro; Nigro, Gerardo; Ziacchi, Matteo; Rordorf, Roberto; Pieragnoli, Paolo; Di Grazia, Angelo; Ottaviano, Luca; Francia, Pietro; Pisanò, Ennio; Tola, Gianfranco; Giammaria, Massimo; D'Onofrio, Antonio; Luca Botto, Giovanni; Zucchelli, Giulio; Ferrari, Paola; Lovecchio, Mariolina; Valsecchi, Sergio; Viani, Stefano. - In: EUROPACE. - ISSN 1532-2092. - 25:6(2023), pp. 1-8. [10.1093/europace/euad158]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1688172
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